Based on the following address: (7308 South 142nd Street Omaha, NE 68138) ... how much time will it take to get to this location? (typical treatment cycle is 11 visits)

""

8.

What is the primary phone number (include area code) to use for contact and leaving messages?

250 characters remaining
""

9.

What is your marital / relationship status?

""

10.

Please select the most accurate response to your eligibility to work in the USA, your residency, and your citizenship.

""

Please enter your country of birth, any information related to "not" being a permanent resident, and/or non-citizen credentials to be able to legally work.

11.

Please select the most accurate response to your experience in donating your eggs.

""

Please provide any information related to your previous applications and/or donations whether they were with our organization or not.

12.

Closest description of your race. Note: Combinations of multi-racial descriptions are only in 1 menu. For example, "Black and Latin/Hispanic" is not listed in "Latin/Hispanic and Black" since they are the same.

Did you have any learning disabilities or significant weaknesses in school that required professional attention?

""

If yes, describe.

20.

Is your work schedule flexible?

""

21.

Have you completed egg donation cycles that have resulted in a pregnancy?

""

22.

Please select the best answer related to smoking habits (including any form of nicotine products, including e-cigarettes).

""

Donating eggs will require no smoking and this will be tested. If you smoke, are you willing to quit?

23.

What period of time did you use tobacco products (ie: 6 months, 2 years, 5 years, etc)?

250 characters remaining
""

24.

When is the last time you had marijuana?

""

25.

When is the last time you have used other recreational drugs such as: Cocaine, Barbituates, Narcotics, Opiates, Amphetamines, Hallucinogens, Tranquilizers (non-medical), PCP, Inhalants, Steroids (non-medical), Ecstacy, or other recreational drug for NON-MEDICAL purposes?

""

Please provide the name of the drug.

26.

What date was the last time you used marijuana/recreational drugs?

1000 characters remaining
""

27.

What is the most number of consecutive days that you have been incarcerated?

""

28.

Please select the most accurate answer for the following question about smoking, drinking, marijuana and other drugs (Cocaine, Heroin, etc).